Pembe Ethem, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

Practice address

617 Veterans Blvd Ste 107
Redwood City, CA 94063-1404

Phone

(650) 204-4204

NPI assigned

Jul 13, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 26, 2023 through Jan 26, 2027

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Wise Mind Institute, a Psychological Corporation

  • Psychologist
  • Redwood City, CA
  • NPI 1174990360
  NPD
• Corrections and Rehabilitation-Headquarters

  • Pharmacy
  • Represa, CA
  • NPI 1154953529
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674000000000",
    "number": "1841674579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "617 VETERANS BLVD STE 107",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940631404",
            "telephone_number": "650-204-4204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 VETERANS BLVD STE 107",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940631404",
            "telephone_number": "650-204-4204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHEM",
        "first_name": "PEMBE",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-07-13",
        "last_updated": "2023-01-18",
        "certification_date": "2023-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pembe@thewisemindinstitute.com",
            "affiliation": "N",
            "address_1": "617 Veterans Blvd Ste 107",
            "city": "Redwood City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "940631404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Svetlana M Esquivel, MSW
• Hannah Carly Esterman, PT, DPT
• Rudolf Estess, DO
• Kate Iris Estkowski
• Donald Estrada
• Georgette Etori
• Jennifer Miguel Eugenio, REGISTERED NURSE
• Constance McKeown Evans, N.P.
• Laurel Christine Evans, CMT
• Kristen Everett, LMFT 88718

• Psychologist in Redwood City, CA
• Providers in Redwood City, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.